Chapter 8 — Emergency Night Watchman

There's curiosity, there's suspicion, there's also some undisguised contempt like "can a medical doctor also get on the podium?". Front row, third position on the left, Trieu Due Minh is sitting. His expression was very unsightly. I didn't pay attention to him and started talking. From vital signs when the patient is admitted to the hospital, to analyzing each test result, to the process of eliminating differential diagnoses, to the final treatment plan and transformation. Logic is clear, data is complete, speaking speed is stable. When it comes to the key differential diagnosis page, I pause for a moment.
"This case could easily be misdiagnosed as DIC. But the classic presentation of DIC should be consumptive coagulopathy—low fibrinogen, low platelets, markedly increased D-dimer. And the patient in this case had fibrinogen 2.8 grams per liter, normal; platelets 231 times 10 times 9, normal; only PT and INR were extremely prolonged, APTT was moderately prolonged. This suggests a coagulation disorder limited to the vitamin K dependent factors.”
Under the podium, someone nodded. There were also people who bowed their heads and flipped through the case summary in their hands, comparing my data. I continue.
"Considering that the patient is a young female, has no liver disease, is not taking anticoagulants, and has a silent onset and rapidly progressing, exogenous vitamin K antagonist poisoning should be given top priority. After trying treatment with intravenous vitamin K1, two hours later the INR from greater than 10 decreased to 6.2, confirming this guess. Subsequent toxicology testing confirmed it was bromadiolone."
PPT moves to the last page: treatment process and transformation.
"After three weeks of continuous high-dose vitamin K1 treatment, the patient's blood clotting function completely recovered. Judicial examination confirmed the fact that the patient's husband poisoned him, and has now been approved for arrest."
I closed the presentation pen.
“The above is my report, I hope the teachers can advise.”
Quiet for two seconds. Then applause rang out. Not the kind of sporadic, cursory applause. It's real recognition. The head of the Laboratory Department, sitting in the back row, was the first to raise his hand and ask: "Doctor Tham, how long was your judgment window at that time?"
“From receiving the patient until deciding to use the test drug, about fifteen minutes.”
“Within fifteen minutes, eliminating DIC, liver failure, congenital coagulation factor deficiency, locking in rat poison—how did you achieve this speed?”
I thought a bit.
"The method of elimination. Fibrinogen and platelets are normal, ruling out DIC. Liver function is only mildly abnormal, not enough to explain an INR greater than 10, ruling out liver failure. Congenital coagulation factor deficiency will not suddenly cause disease, ruling out. The rest is only exogenous—and rat poison is the most common."
The head of the Laboratory Department nodded and wrote something in the notebook. The second person who asked the question was from the Department of Pharmacy: "How do you determine the dosage and course of vitamin K1?"
"The initial dose is 10 milligrams by slow intravenous injection. The half-life of bromadiolone is extremely long, can reach 20 to 30 days, so vitamin K1 needs to be continued for at least six to eight weeks, periodically monitoring the INR until stable."
“Very professional.”
More questions followed one after another. I answered one after another, without stumbling. Phuong Chinh Thanh sat next to him next to him, without saying a word, holding a cup of tea, his face calm. But I noticed that the corner of his mouth had an almost invisible curve. Trieu Due Minh did not raise his hand the whole time. He leaned against the back of the chair, his arms crossed over his chest, the expression on his face was like swallowing a fly. After the meeting ended, everyone dispersed. I packed up my USB and was about to leave when I heard footsteps behind me.
“Shen Yen.”
I turned around. It's Chu Yen Binh of the Department of Cardiovascular Surgery. Today he did not wear surgical clothes, dressed normally, under the blouse was a dark blue turtleneck sweater. It looks much more spirited than when we met at dawn.
“Not bad said.” He said, his voice casual as if he was evaluating the food in the cafeteria today.
“Thank you, Director Chu.”
“Don't call homeroom, you sound old.” He leaned against the door frame and looked at me, "The patient who had surgery last time has been discharged from the hospital. He has recovered very well. He wants to thank you personally, I will leave you his phone number."
"Yes."
“There's more.” He took out a business card from his pocket and gave it to me, "In the future, if you have a heart-related emergency, you can call my phone directly. No need to secretly write down the number anymore."
I received the business card, my ears felt a bit hot. He knew I secretly wrote down the previous number.
"… Yes, thank you."
He nodded once and left. When passing through the door, pass Phuong Chinh Thanh. The two exchanged a look. Phuong Chinh Thanh waited for everyone to leave before slowly walking forward.
“Have you put your business card away?”
“Um.”
“Chu Yen Binh, this person does not easily give business cards to others.” Phuong Chinh Thanh looked at me, "A bunch of the main doctors in the Cardiovascular Surgery Department couldn't even get his personal number."
I don't know what to say.
"Okay, let's go. Bed number three has to be extubated this afternoon. Go get ready."
The doctor gives daily instructions, seamless transitions.